| NPI | 1093796534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J8422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR C8316) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2012-07-24 |